Contents
•	Overview
•	Rotations
•	Residency Training
•	Fellowships
•	Application Process
•	Faculty
•	The Community
•	Student Program
•	Current Residents
•	Miscellaneous

Continuing Education

Fellowship Program Application (link)

FELLOWSHIP IN MATERNAL-FETAL MEDICINE

I. GENERAL DESCRIPTION

The fellowship is currently approved for three positions by the American Board of Obstetrics and Gynecology with one fellow at each year of a three year program. Requirements include completion of an approved Residency in Obstetrics and Gynecology and eligibility for the American Board of Obstetrics and Gynecology and New Jersey licensure.

The main clinical sites for the fellowship are Robert Wood Johnson University Hospital and Jersey Shore University Medical Center. However, the faculty of the Division provides MFM services for five additional hospitals in central New Jersey. The Regional Perinatal Center at Robert Wood Johnson University Hospital is a referral center for complicated pregnancies in a central New Jersey catchment area covering 18,000 deliveries. The Division is staffed by 8 MFM faculty physicians, one clinical geneticist, one molecular biologist, three MFM fellows, two full-time perinatal epidemiologists, two research nurses, three genetic counselors, one nurse clinical specialist and sixteen ultrasound technicians.

Additional faculty from the Department of Obstetrics, Gynecology and Reproductive Sciences and faculty from other departments of the Medical School participate in the educational experience of the fellow.

The fellow participates in a variety of experiences which cover the entire clinical range of Maternal-Fetal Medicine supplemented by formal lectures, courses (Biostatistics and Genetics) and research activities. This 3-year fellowship program includes 18 months of full-time clinical activity and 18 months of research activities. A didactic program of two university courses, formal lectures and conferences cover important topics in the field. Fellows are responsible for literature reviews and presentations and participate in the educational programs for medical students and residents.

The Division maintains one of the most academically productive research programs in the United States. The research activities of the Division are in both clinical and basic science areas, and the fellows are expected to participate in several projects. At least two research projects are expected to be completed and submitted for publication by the end of the fellowship. The research activities of the Division are complemented by a well-equipped ultrasound unit and other research laboratory facilities. In addition, an extensive perinatal computer network of local, regional and national perinatal data is available to facilitate fellows’ research.

The on-call schedule is approximately every 8th night and every 4th weekend (one day). The fellow functions essentially as a faculty member and attending soon after entry into the program. However, a full-time faculty member is always on-call with the fellow.

Approximately 18,000 deliveries take place in the central New Jersey area. Over 4,000 deliveries occur at our main clinical sites and a large number of these are high-risk because of an extensive referral service, our very active High-Risk Obstetric Clinic and the high-risk practice of the Maternal-Fetal Faculty in surrounding facilities.

Referred high-risk patients are seen in an ambulatory setting throughout their pregnancies. Frequently, these patients are seen prior to pregnancy, for pre-conceptional counseling, because of a previous obstetrical complication or specific risk factor. Special services (for referral) include: Fetal Cardiovascular Service, Genetic Sonography, First Trimester Aneuploidy Screening, Perinatal Genetics, Recurrent Pregnancy Loss Service and Preterm Birth Evaluation and Prevention Service. Recently, we have started an invasive fetal therapy surgery and treatment program using endoscopic laser and radiofrequency ablation techniques. Additionally, an active Maternal-Fetal transport service receives patients with more acute problems. The fellows have an active role in all these special services and patients.

Our ultrasound and prenatal diagnosis unit, a unit of the Division of Maternal-Fetal Medicine, investigates patients who have had current or prior problems and helps manage them through their pregnancies. Incorporated into this evaluation may be non-stress testing, biophysical profiles, amniocenteses, chorionic villus sampling, ultrasounds, percutaneous umbilical blood samplings, and intrauterine transfusions. The unit is adjacent to Robert Wood Johnson University Hospital and is equipped with 5 state-of-the-art ultrasound machines, all with color Doppler capabilities and computerized data collection. The ultrasound facilities at other sites are similar. The unit is operated by the Maternal-Fetal Division and provides direct "hands on" experience for the fellows. Ultrasound equipment with 3D/4D capabilities is available at clinical sites

A very active perinatal genetics service is staffed by three masters trained genetic counselors. A medical geneticist provides additional support for this program. The Division of Maternal-Fetal Medicine performs approximately 1,100 procedures each year, including amniocentesis, Chorionic Villus Sampling and Percutaneous Umbilical Blood Sampling.

The University graduate courses offered are "Biostatistics I" and "Human Genetics."

Five formal conferences take place each week. During the weekly Research Meeting, the progress of all research projects is summarized and new projects are discussed. Twice weekly Chairman’s conferences cover a wide range of MFM topics in a case-based teaching format. Other meetings include a joint Perinatal Conference held with the Department of Neonatology, Placental/Perinatal Pathology, an Ultrasound Review, didactic Fellow Presentations, Journal Club, and a monthly meeting of the Department of Obstetrics and Gynecology. The academic schedule of the Department of Obstetrics and Gynecology includes a Visiting Professor lecture on Friday morning and a variety of other programs.

The complete range of obstetrical anesthesia including epidural anesthesia is provided by full-time physician anesthesiologists.

The high-risk obstetric clinic involves the fellow in a wide range of pregnancy problems. Nutritional and psychosocial counseling are available with the incorporation of appropriate allied health personnel.

In addition, ongoing communication and perinatal outreach is maintained with various clinics, surrounding hospitals, family practice centers and obstetricians who refer their complicated obstetrics to the Maternal-Fetal Medicine Division.

Several grants for the improvement of pregnancy outcome have been obtained. These grants provide for a multi-disciplinary approach to pregnancy with improvement of access and quality.

The fellowship provides a complete experience in all aspects of Maternal-Fetal Medicine with extensive contact and teaching by the full-time hospital based faculty.

II. NARRATIVE DESCRIBING RESEARCH OPPORTUNITIES FOR THE FELLOWS

The research opportunities for the Maternal-Fetal Medicine fellows are based on the following elements:

1. AVAILABILITY OF OBSTETRIC POPULATIONS. The clinical activities of the Division of Maternal-Fetal Medicine operates at two primary hospitals (RWJUH and Jersey Shore University Medical Center). Of the 4000+ deliveries, approximately one-third are clinic patients whose care is provided by the UMDNJ-Robert Wood Johnson Medical School residents and fellows under the direct supervision of Maternal-Fetal Medicine faculty members. In addition, the MFM Division directly cares for over 200 high-risk obstetrical patients per year in their private practice as well as approximately 200 patients transported from other health care facilities. The Division also supervises the care of nearly 200 high-risk clinic patients annually referred from around Central New Jersey.

The various ultrasound facilities are equipped with state-of-the-art 3D/4D ultrasound machines with color flow Doppler capabilities. Approximately 18,000 ultrasound examinations are performed each year with half of the examinations being performed on clinic as well as MFM patients. The MFM fellows and faculty provide the entire coverage for the ultrasound unit in which a variety of procedures are carried out including targeted sonography to assess fetal anomalies, nonstress tests, biophysical profiles, Doppler velocimetry, fetal echocardiography, percutaneous umbilical blood sampling, chorionic villus sampling and amniocentesis.

2. LARGE MFM DIVISION WITH DIVERSITY IN CLINICAL TALENT AND EXPERTISE. The Division of Maternal-Fetal Medicine consists of 8 full-time faculty members. The diversity in talent and expertise of the MFM physicians are reflected in their functional titles as follows:

Joseph C. Canterino, MD
Associate Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center
Director, Perinatal Genetics

Susan Janeczek, DO
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Director, Undergraduate Medical Education in Maternal-Fetal Medicine
Director, Diabetes in Pregnancy Program

Maria E. Martins, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Director, Chorionic Villus Sampling Services

Paul Matta, DO
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Myriam Mondestin-Sorrentino, MD
Assistant Professor
Associate Director, Pregnancy Loss Evaluation Service
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Yinka Oyelese, MD
Assistant Professor
Director, High-Risk Pregnancy Services
Department of Obstetrics, Gynecology and Reproductive Sciences

3. BASIC RESEARCH FACILITIES. The OB/GYN Department Perinatal Biology laboratories, directed by Morgan R. Peltier, PhD, are located in New Brunswick, New Jersey adjacent to our clinical and academic offices and offers resources for cell biology studies, protein analysis, PCR and immunohistochemistry. Areas of interest include a) inflammation pathways, b) mycoplasma virulence, c) and immunity mechanisms of the cervix, vagina, and placenta. Additional laboratory facilities located in Piscataway, New Jersey are directed by William Moyle, PhD and four technicians. The research activities of this group fall into two broad categories, namely (a) studies of the structure and function of glycoprotein hormones and (b) studies of the structure and function of the receptors of glycoprotein hormones. The main focus of the laboratory is to provide new information about the interactions of reproductive hormones and their receptors as related to fertility and pregnancy. An additional research laboratory is being established within the department to support a variety of molecular biology related studies involving RNA expression, PCR, protein isolation, electron microscopy and immunohistochemistry. Basic research opportunities also exist in collaboration with: (1) the Department of Pediatrics Genomics Laboratories; (2) the Division of Neonatology, Cytokine/Inflammation program; (3) the Rutgers School of Pharmacy Extracellular Matrix laboratories directed by Emmy Gordon, PhD; (4) the environmental laboratories of the Environmental and Occupational Health Sciences Institute; (5) Proteomics New Jersey Medical School, Newark; and (6) UMDNJ Child Health Institute, New Brunswick.

4. AVAILABILITY OF A FULL-TIME EPIDEMIOLOGIST AND BIOSTATISTICIAN. The department has a Division of Epidemiology and Biostatistics staffed by a full-time perinatal epidemiologist/biostatistician. The Division Director is Cande V. Ananth, PhD, MPH. Dr. Ananth is available to the MFM fellows for helping with study design, statistics and statistical analysis and participates in all weekly research meetings of the Division. He also provides bimonthly lectures on biostatistics and epidemiology. Additional personnel are being recruited to assist Dr. Ananth as the Division grows.

5. AVAILABILITY OF FULL-TIME RESEARCH NURSING STAFF. The Division of Maternal Fetal Medicine has one full-time nurse researcher. The research nurse is experienced in protocol development, study coordination, data collection, data base design and patient recruitment. In addition, she is available to assist with informed consent and enrolling patients into clinical research protocols.

6. AVAILABILITY OF COMPUTERIZED PERINATAL DATA SYSTEMS. The MFM Division has already in place and fully functioning two clinical information systems for the Labor and Delivery Suite and the ultrasound unit. A newly updated Observer™ computer system for our ultrasound unit runs on a departmental wide network. There are data entry workstations located in the ultrasound examination rooms and workstations in the dedicated reporting rooms. This data storage and reporting system provides the capability for the direct downloading of biometric information acquired during the ultrasound evaluations, as well as image archiving. The described perinatal data systems provide a unique opportunity for the fellows to conduct clinical research studies.

7. AVAILABILITY OF A CLINICAL RESEARCH CENTER. The clinical research center of the Robert Wood Johnson Medical School is a combined in-patient and out-patient facility with extensive experience in administration of clinical research protocols. It includes 12 licensed in patient beds with a capacity to expand to 16, including 4 beds equipped with electronic monitors for electrocardiographic and invasive physiologic studies. There are also 4 out-patient clinic rooms in the facility with a phlebotomy suite which can accommodate several hundred patient visits per week. The center offers the fellows the opportunity to conduct many safety and tolerability studies, as well as pharmakokinetic drug trials.

8. DIVISIONAL RESEARCH INTERESTS

Pre-Pregnancy Health

• Screening strategies to correctly identify women at high-risk for perinatal
  complications
• Folic acid supplementation to prevent birth defects
• Treatment of medical conditions that can affect perinatal outcomes
• Define racial and ethnic contributions to pre-pregnancy health that affect perinatal outcomes
• Pre-pregnancy evaluations of previous medical, obstetric and neonatal complications to help design treatment strategies for before, during and after pregnancy

Preterm Birth Research

• Infection
• Apoptosis (programmed cell death)
• Ultrasound as a screening tool to predict preterm birth
• Population-based risk factor analyses
• Population-based infant outcome studies
• Preterm infant follow-up studies (prediction of morbidity and mortality, respiratory function, neurodevelopmental function)
• The extracellular matrix in membranes, cervix and uterus
• The extracellular matrix in newborn vascular adaptation to life outside the uterus
• Immunologic aspects of prematurity (inflammation, immune tolerance, immune system dysfunction)

Hypertensive Diseases of Pregnancy

• Screening for at-risk women using ultrasound and Doppler evaluations
• Monitoring and managing pregnancies with preeclampsia
• Placental abnormalities with preeclampsia
• Blood clotting disorders (thrombophilias) as risk factors
• Population-based risk factor analyses
• Population-based infant outcome studies
• Markers of oxidative stress with preeclampsia
• Prevention trials
• Vascular reactivity

Fetal Growth

• Non-invasive ultrasound Doppler assessments of altered maternal vascular reactivity and uteroplacental blood flow blood flow
• Management of pregnancies at high risk for abnormal fetal growth
• Mechanisms of fetal and neonatal nutritional compromise
• Neonatal and infant outcomes
• The long-term consequence of abnormal fetal growth
• Population-based risk factor and outcome studies
• Prevention trials

Fetal and Neonatal Brain Development

• Normal and abnormal fetal behavior as a predictor of neurologic function
• New techniques for assessing fetal and neonatal neurologic function
• Imaging: Ultrasound, (MRI), and EEG
• The role of oxidative stress and inflammatory injury in neurologic development
• The effects of abnormal fetal growth and low birth weight on neurologic function
• Predictors of developmental outcomes
• Interventions to improve developmental outcomes in at-risk infants
• Long-term follow-up of at risk infants

Birth Defects and Prenatal Diagnosis

• Epidemiological studies of congenital abnormalities
• Improved ascertainment and tracking of diagnosed congenital abnormalities
• UMDNJ New Jersey Fetal Abnormalities Registry which is a cooperative effort with the NJ Department of Health and Senior Services and the Centers for Disease Control and Prevention, Atlanta, GA.
• Etiology studies
• Application of cost efficient screening strategies
• New diagnostic modalities (testing and imaging)
• Management of diagnosed congenital abnormalities
• Short and long-term outcomes
• Economics of congenital abnormalities

Early Origins of Adult Disease

• Fetal growth restriction/malnutrition
• Prematurity
• Congenital malformations
• Infection
• Hypoxia
• Interventions that can moderate the impact of these conditions on later health
• Follow-up outcome studies

Pregnancy Loss

• Epidemiology
• Cost-effective and evidence-based evaluation strategies
• Immunologic mechanisms of fetal loss
• Disorders of blood clotting systems and fetal loss
• Placental dysfunction
• Gene-environment interactions
• Prevention studies

Perinatal Health Economics

• Information systems development and implementation
• Cost effectiveness/benefit analyses
• Database design and data management
• Relevant outcome assessments
• Condition specific care research

Perinatal Epidemiology and Outcomes Research

• Black-white disparities in adverse perinatal outcomes in the US, including prematurity, fetal growth restriction, fetal and infant mortality.
• The role (both content and timing) of prenatal care on adverse perinatal outcomes.
• Provide recommendations on indication-specific "optimal" prenatal care in the US.
• Secular and temporal trends in the incidence of preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
• Causes of temporal trends in preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
• The role of age, period and birth cohort effects on preterm delivery and small for gestational age births among US blacks and whites.
• Risk factor profiling of obstetric complications among singleton and twin births in the US.
• Gene-environment interactions, as well as familial aggregation of placental abruption, fetal growth restriction, and stillbirth, through family-based case-control studies.
• Developing innovative statistical methodologies for analysis of studies, especially focusing on methods for longitudinal and repeated measures (clustered) data.

III. NARRATIVE DESCRIBING DIDACTIC ACTIVITIES

The didactic activities consist of the following lecture series and conferences:

A. Lecture Series

1. Ob/Gyn/Resident lecture series (every Monday 12 noon to 1:00 p.m.);
2. Ob/Gyn Resident/MFM Fellow/Chairman’s Obstetric case review (every Monday and Wednesday 4:00 – 5:00 p.m.);
3. Grand Rounds lecture series (every Friday of the month, 8:00-9:00 a.m.); and
4. MFM core curriculum lecture series (given by fellow on the last Wednesday of the month, 4:30-5:30 p.m.).

B. Conferences

1. Fetal Ultrasound Diagnosis and Management Conference (every Wednesday 12 noon to 1:00 p.m.);
2. Combined MFM/Neonatal Conference (every second and fourth Wednesday of the month, 1:00-2:00 p.m.);
3. Perinatal Genetics Conference (every first Wednesday of the month 1:00-2:00 p.m.);
4. MFM Journal Club (given by the fellow the third Wednesday of the month, 1:00-2:00 p.m.);
5. Perinatal Pathology Conference (fifth Wednesday of the month 1:00-2:00 p.m.);
6. MFM Patient Care Conference (every Friday 12 noon to 1:30 p.m.)
7. Departmental Morbidity and Mortality Conference (every third Wednesday of the month, 8:00-9:00 a.m.).

C. MFM Research Meetings

MFM research meetings are conducted every Wednesday from 4:30-6:30 p.m., except the last Wednesday of each month, which is dedicated to MFM core curriculum topics as well as Journal Club. These include epidemiology and biostatistics core and laboratory research techniques lectures every other month.